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suicidal ideation... simple thoughts vs. active threats


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Didn't quite know where to put this, so being a BPDer and suicidal ideation being a characteristic of BPD, here it is. Mods, please move if necessary.

Why do people assume they are one and the same, lumping it all together no matter where your feelings actually are on the spectrum? That if you simply express a desire or a feeling about dying (or IMO more often simply Not Being as opposed to actively doing yourself in), even if you don't have any concrete plan for carrying it out and "just" wish or daydream, it's assumed that you are threatening to go kill yourself Right Now, or at least make an extremely serious (meaning really intentional, non-demonstrative) attempt at doing so? It makes it so hard to confess these feelings to one's MH professionals because of the patient's fears of potential repercussions, like involuntary hospitalization in some really awful places or overmedication, even though getting them out in the light may be helpful in analyzing where they're coming from, what to do about them, how significant is the potential for progression, before it's too late?

Even though I trust my tdoc more than I've trusted any medically-related professional/paraprofessional in my life, it still took a couple of Klonopin and scraping up every bit of courage I could find over the course of a couple of weeks to express to her recently that even though I have no actual intent to act on these emotions, I still go to sleep every night wishing I'd have a stroke or a heart attack in my sleep and just not have to wake up to face the next day in hell, or (as I said in another thread) I feel like I'm already dead and haven't had the sense to lie down yet (zombie-like)... because I didn't WANT to feel like this all the goddamn time. It was terrifying because I didn't know what was going to happen as a result of opening up like that, whether I was going to go home or be plunked willy-nilly into a police car or ambulance.

:wall:

OUAT

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Yes, that is very frustrating. I have very minor suicidal ideation quite frequently and luckily my current psychiatrist is content to let me tell her when she should be concerned. She just nods and moves on unless I say that it's really serious.

I think doctors who have experience working with BPD are familiar with that kind of chronic low-key ideation. The good doctors I've had have been quite familiar and not too concerned with my ideation. Sometimes you get a bad egg though.

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Well, we always have a plan. But many of us really like living a whole lot and have absolutely no intention of ever acting on the plan. But it's always there, and if circumstances change we sit down and make another plan that we can agree on. It's something that we've done for so long that it's comforting.

We just have enough sense (or lack enough sense) to ever mention that we have a plan.

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tryp - I'm very fond of my tdoc. Sheer dumb luck on my part to find the only person in the area who specializes in BPD and DBT, and at that time I didn't even HAVE a BPD dx and didn't know DBT from a DPT vaccination - all I knew was that I was looking for a solid "skills-based" form of therapy instead of the "endless yapping" I'd spent years wasting time and money on. (I had also had, although he recently retired, virtually the only pdoc in a reasonable trek who was actually interested in multi-dx, polypharm patients. Doc-surfing for a replacement now - pdoc had developed such a large caseload of "toughies" over the years that the locals willing to deal with us have filled up quickly. I've had so many bad eggs over the last dozen years you can probably still smell the sulfur!)

But even she overreacted when I asked for help on that issue first time around, went way too far to the end of the spectrum I was frantically trying to scramble away from, which is why I was flaked like Tony the Tiger to address the issue again even when both opening up or staying clammed were equally shitty options. It was better this time around because I did really sledgehammer that disclaimer to which y58 refers (and said big slug of Klonopin), but still to have to be that scared with someone you've already worked so hard to trust... is that really necessary?

jt07 - that is EXACTLY my point - I found out the hard way and came out of it a hell of a lot worse than I went in, and it took a long time for me to trust again. The fear/frustration (fearstration?) point is that many if not most pdocs/tdocs aren't seeing the spectrum of emotion/ideation, they're knee-jerking on ANY expression of it, which left me (and I'm sure leaves many others) unwilling to bring these feelings out to where something can be done about them instead of letting them fester as I have too often in the past. Maybe they're just covering their asses on lawsuits, I dunno.

(I'm not saying that all pdocs/tdocs are like this. Just too many.)

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I've actually not had trouble with this (even though I originally presented after a suicide attempt, oddly). My docs know that my suicidal ideation is chronic and rarely not present at all (but also usually not dangerous), and it doesn't seem to phase them when I express this. Frankly, it doesn't even seem to phase them when it really worries me, so perhaps they're a bit too far to the other end of the spectrum of reactions.

Maybe your tdoc just needs to get to know this aspect of you better. Now that you've brought it up twice without acting on it, I'm sure she'll start to get used to it.

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I always struggle on this one. I'm in the sort of consant low-key ideation phase most of the time. I feel like dying, but I'm not going to off myself. Unfortunately, 'm the kind of person who has a plan in place all the time. So, yeah. Doctors don't seem to be able to comprehend the idea that having a plan =/= wanting to kill myself, either.

Just include a standard disclaimer. "I'm not planning on killing myself right now."

At least where I am, they're unlikely to hospitalise you on the spot. They wait for you to do it, land in hospital, and then they section you.

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anyone ever try Neurontin/Gabapentin? I'm diagosed as psychotically depressed, and the only thing that's worked to get me out of the depression toilet is Adderall (amphetimes), but the crashes are becoming unbearable. Neurontin/Gabapentin in combo with Klonopin seem to help to 'buffer' the crash. But, every fucking day/night, the suicidal ideations come: some days, they're vivid. And, yes, I've tried, 3 years ago. Quite the mess. But all these damn mood stabilizers just have too many side effects. God damn it! They bloat and pork you out. I really want my girlish figure back (I'm a guy, so speaking metaphorically )

Another wonderful side effect is (now 2:15am) insomnia. I've started a job last Monday, and I'm supposed to 'project' as a gung ho professional. Little do they know how fucked up I am. "it's all an act", and I constantly "wonder" how many are "on to me". A tad paraoid? Well, yea, I realize, but it doesn't help (knowing, that is). Just thought i'd vent.

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Sorry for being so late getting back to this - I'll address that in a separate post (probably tomorrow, I just realized I'm rapidly running out of brain).

hallowedink - in my state (northeastern USA) you can get chucked in the bin for an involuntary 3-day hold if a MH professional THINKS you might be "a risk to yourself or others". THINKS. That's all. Don't need proof of any kind, just an opinion. Don't even need a second opinion from another doc. Previous hospitalization and a history of self-harm, even if you don't have any injuries at the time, really tip the scales toward getting binned, too. That 3-day can become 4 or even 5 if you've got the shit luck for it to be over a weekend, too, since at the hospital where I was the staff pdocs aren't there to do release screens on weekends, there's only a substitute pdoc whose primary job is to sign medication orders. I agreed to my first hospitalization (which was such a clusterfuck it's absurd), but when I got out I told both my pdoc and tdoc the only way they were getting me back in there was with five-point restraints and elephant tranquilizers.

drey1024 - I'm sorry, I can't help. I was briefly on Neurontin about 15 years ago for neuropathic pain, but it did nothing for my mood (but I also don't have psychotic-type depression). For the most part I've done well with Lamictal for a mood stabilizer - side effects yes, but they're tolerable especially compared to the other options on the table, and it's about the most weight-neutral one I know of. I simply can't/won't take any of the meds that cause weight gain, I'm already obese from past meds and physical disabilities that make exercise extremely difficult, and I'm at extremely high risk for diabetes from a genetic standpoint as well. Have you posted this over on the depression board, or maybe the meds board? I can sympathize with the insomnia, I've had both primary (falling asleep) and secondary (sleep continuity) insomnia for my entire life, just part of my basic wiring, and it sucks big-time.

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  • 3 weeks later...

I don't care if I am holding the gun to my head, I will never again mention to anyone that i want to die. Getting forced into the mental hospital for a drugged up 3 day stint was the most depressing, suicidal thought causing situation that has ever happened to me. Again? Nooo thanks.

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Because of a lot of people being admitted here (southern Ontario, Canada) they don't admit lightly. They will some days, when its "slow", and there aren't many people in the bin, but once I went in with a concrete plan to kill myself and they sent me to a mental health house. In the end, it worked out better anyways.

If I present in the ER with an MI issue, I tell them if I'm suicidal or psychotic (if I'm aware of it) or not.

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I don't care if I am holding the gun to my head, I will never again mention to anyone that i want to die. Getting forced into the mental hospital for a drugged up 3 day stint was the most depressing, suicidal thought causing situation that has ever happened to me. Again? Nooo thanks.

torirae, what were the worst parts about it? Why so bad?

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I don't care if I am holding the gun to my head, I will never again mention to anyone that i want to die. Getting forced into the mental hospital for a drugged up 3 day stint was the most depressing, suicidal thought causing situation that has ever happened to me. Again? Nooo thanks.

Not all psych wards are bad. Speak with your pdoc and see which one s/he is registered at. Make sure that if you're going in then you go to that one - that way your pdoc will be able to help you. Also, definitely try and get into therapy - sounds like you need it.

N

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torirae,

I had the shotgun in my mouth before I decided to call my tdoc. She told me to go to the ER and she would call ahead so they would be ready for me. Everything went very well. First I had an extensive talk with a tdoc and then with a psych nurse before they decided to admit me. I was there for 2 weeks, but it wasn't bad at all. We even got to smoke 4 times a day.

Tommy

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